Zusammenfassung
Hintergrund Die akute Netzhautnekrose (ARN) kann eine kombinierte medikamentös-chirurgische Therapie erfordern, deren Erfolg nur in kleinen Fallzahlen dokumentiert ist.
Patienten und Methoden Wir berichten über die Ergebnisse der klinischen Untersuchung, Kammerwasserdiagnostik und Therapie von 10 Patienten (14 Augen) mit ARN, die bis zu 36 Monate (durchschnittlich 20 Monate ± 10) nachbeobachtet wurden.
Ergebnisse Die virale Genese wurde in 9 von 10 initialen Kammerwasserpunktaten bestätigt. Sieben Proben wiesen VZV-, 5 gleichzeitig HSV- und 2 Proben CMV-Antikörper auf. In 3 Augen verlief die ARN mit einem Visus von 0,6 oder besser milde. Bei 6 Augen konnte ein Visus von 0,3 - 0,1 durch Vitrektomie und Silikonöltamponade erhalten werden. Vier von fünf Augen erblindeten durch Vaskulopathie, Optikusneuropathie oder Ablatio retinae. Bei einem Patienten wurde ein Arterienastverschluss durch Vollheparinisierung behandelt.
Schlussfolgerung Die Kammerwasseranalyse unterstützt die klinische Diagnose. Die frühzeitige Vitrektomie mit Silikonöltamponade kann eine brauchbare Sehschärfe erhalten. Vaskulopathie und Optikusneuropathie sind Hauptursachen später Komplikationen und bedürfen stärkerer Berücksichtigung.
Purpose Acute retinal necrosis syndrome (ARN) might be complicated by retinal detachment, vasculopathy and optic neuropathy and has a poor prognosis despite intensive medical and surgical therapy.
Patients and Methods A series of 10 consecutive patients (14 eyes) with ARN were followed for 36 months (average of 20 months ± 10). We present the results of the clinical evaluation for diagnostic and therapeutic modalities.
Results Viral etiology was confirmed in 9 of 10 aqueous-humor samples. Intraocular antibody synthesis against Varicella-Zoster Virus was found in 7, against Herpes-Simplex Virus in 5 and against Cytomegalovirus in 2 samples. Three eyes had a mild clinical course with a visual acuity of 0.6 or better. Vitrectomy and silicone-oil tamponade preserved visual acuity from 0.3 to 0.1. ARN lead to blindness in 5 eyes due to vasculopathy, optic neuropathy or retinal detachment. An arterial branch occlusion was successfully overcome with iv. heparin treatment in one patient.
Conclusion Aqueous-humor analysis supports clinical diagnosis. Early vitrectomy and silicone oil tamponade stabilizes retinal structure and preserves visual acuity. Occlusive vasculopathy and optic neuropathy are the main causes leading to blindness.
Schlüsselwörter
Akute Retinanekrose - Herpesviren - Kammerwasseranalyse - Vitrektomie
Key words
acute retinal necrosis - herpes virus - aqueous humor analysis - vitrectomy
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